Treating for blood pressures in the 140/90 to 160/99 mmHg range reduced stroke and mortality risks, according to a meta-analysis of patient-level trial data.

Treating mild hypertension with an antihypertensive drug or more intensive regimen yielded a significant 28% relative reduction in incident stroke compared with placebo or a less intensive blood pressure-lowering regimen over 5 years, Kazem Rahimi, MD, of the George Institute for Global Health at the University of Oxford, and colleagues found.

The strategy also cut the risk of death from any cause (odds ratio 0.75, 95% confidence interval 0.57-0.98) and from cardiovascular causes (OR 0.78, 95% CI 0.67-0.92) over that period in the fairly uncomplicated primary prevention patient populations studied across the trials.

Other endpoints trended the same direction without reaching statistical significance, the group reported online in the Annals of Internal Medicine. Odds ratios with antihypertensive or more intensive regimens versus none or less-intensive regimens came in at:

0.86 for total cardiovascular events (95% CI 0.74-1.01)

0.91 for coronary events (95% CI 0.74-1.12)

0.80 for heart failure (95% CI 0.57-1.12)

A prior meta-analysis of three trials in patients without diabetes had suggested no significant benefits from treating mild hypertension.

Rahimi's meta-analysis included 15,266 patients from 10 comparisons in Blood Pressure Lowering Treatment Trialists' Collaboration trials, in which most patients had diabetes, along with the three trials in patients without diabetes, from which only aggregate data was available.

The average blood pressure reduction was about 3.6/2.4 mmHg, and patients were followed for an average of 4 to 5 years.

"The modest blood pressure reductions achieved and the moderate numbers of events recorded meant that confidence intervals were wide for all outcomes, and the power to test the hypothesis of protection was limited in every case," the researchers noted.

"Nonetheless, the findings suggest that blood pressure reduction is likely to provide benefit among patients with grade 1 hypertension and that these benefits could be substantial, particularly among patients at elevated absolute cardiovascular risk."

The findings were "timely in light of a recent guideline that recommended relaxing blood pressure goals in patients older than 60 years (the population at highest risk)," Wright noted.

"In addition, although all other U.S. and international guidelines continue to recommend antihypertensive drug treatment to achieve blood pressure targets less than 140/90 mmHg at least up to age 80 years, the National Committee for Quality Assurance has relaxed its target blood pressure quality metric from less than 140/90 mm Hg to less than 150/90 mm Hg in patients older than 60 years."

The researchers also broke out the findings for patients treated in accord with those controversial guidelines from what was to have been the 8th Joint National Commission and showed similar results as in the overall analysis.

American Heart Association president Elliott Antman, MD, of Brigham and Women's Hospital and Harvard in Boston, said the findings affirm the last official JNC guidelines (JNC7) and those of the AHA and American College of Cardiology.

"We're in midst of updating our hypertension guideline," he told MedPage Today. "This article supports the concept that it would be ill advised to move to a systolic of 150 to begin to treat hypertension."

However, Wright noted that the meta-analysis was done with data comparing achieved blood pressures in trials where the primary objective was not to compare treatment versus no treatment specifically for mild hypertension.

He warned that the strength of evidence was not equivalent to that in a prospective trial, although such a trial is not likely to be done.

"Furthermore... [the] review does not inform whether treatment of hypertension in this range benefits patients older than 60 years because data from such patients were excluded," he wrote.

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